Questions: Please contact Susan Gibson (UW Bothell School of Business Assistant Director) at 425.352.5255 or sgibson@uwb.edu.

Disclaimer: This is a UW Bothell School of Business non-degree program. Participation in this program does not result in academic credit toward a degree.

The University of Washington is committed to providing access, equal opportunity and reasonable accommodation in its services, programs, activities, education and employment for individuals with disabilities. To request disability accommodations contact Disability Resources for Students at 425.352.5307, TDD 425.352.5303, FAX 425.352.3581, drs@uwb.edu. It would be best if requests are made 10 days prior to an event.

Contact Information

* Is this your first BOLD event? (yes or no)

* How many BOLD events have you previously attended? (type a number in the box)

* How did you hear about BOLD? (check all that apply)

* First Name

* Last Name

* Middle Initial

Street

Apt/No.

City

State

ZIP

Phone

* UW Email

* Alternate Email

* UWB Student ID Number

* Class Level

Bothell Concentration

Bellevue Concentration

* Academic Program

Anticipated Graduation Year

Release, Clearance, and Authorization to Record

I enter into this release with University of Washington ("the University").

I authorize the University to create recordings of my image, likeness, and/or voice ("Recordings") in connection with my presentation and/or participation at the Event. I agree the Recordings may take the form of photographs, films, video and audio tapes, CD-ROMs, DVDs, digital files, streaming media and/or any other media. The University may use the Recordings at the University's discretion. The University may use and license others to use the Recordings in their original or edited form in any media for any and all educational and commercial purposes, and may use and license others to use my name, image, or likeness, voice, and biographical or other information in connection with the Recordings.

I hereby waive all rights and release the University (including its officials, employees, representatives, agents, licensees, successors, and assigns) from, and shall neither sue nor bring any proceedings against any such parties for, any claim or cause of actions, whether now known or unknown, for defamation, libel, invasion of right to privacy, publicity or personality or any similar matter, or based upon or relating to the use and exploitation of the recording.

In giving permission, I am not limited by any other agreement that I have entered into. I have read and understood this Release and I am over the age of 18. This release expresses the completed understanding between myself and the University with respect to the Recording.

I further acknowledge that I will not be compensated for any uses made of the Recording, and that the University exclusively owns all the rights to these Recordings. However, except for the permissions I am granting here, I retain all rights I may otherwise hold in copyrighted materials included in my presentation and/or incorporated into the Recordings. I agree that I have read and understood the contents hereof, have checked the appropriate choice box which describes my permission, and that I have the right and the authority to execute this release.

By typing my name in the following box I certify the above statements to be true and correct, to the best of my knowledge, and that this information can be used for the purpose of executing this release.